A California social worker’s research into how family behaviors affect lesbian, gay, bisexual, and transgender (LGBT) youths may soon transform how social service professionals promote these youths’ health and well-being.

Caitlin Ryan, PhD, ACSW, directs the Family Acceptance Project (FAP) at San Francisco State University. The project has attracted international attention in recent months after the publication of an article by Ryan and her colleagues this year in Pediatrics that discussed an FAP study showing that lesbian, gay, and bisexual youths whose families reject their sexual orientation and gender expression were at higher risk for several health problems as adults.

Observers say the work of the FAP has groundbreaking implications for social workers and other professionals serving LGBT youths and their families. It provides hard data to support the conventional wisdom that family rejection increases the risk of poor health and mental health outcomes for LGBT children and adolescents. It also shows the importance of taking a family-centered, systems-based view of the environment in which LGBT youths live.

“It’s absolutely critical that we understand the role of the family in promoting the well-being of LGBT young people,” Ryan says. “This is a uniquely social work approach to doing research and implementing it in the world.”

The Research
Ryan developed the FAP in 2002 to provide research-based educational materials and interventions to strengthen families and their support of their LGBT youths. Related goals include improving the health, mental health, and well-being of LGBT youths; helping create an environment in which LGBT youths can stay in their homes; and informing public policy.

The article in Pediatrics was the first paper to disseminate the results of the FAP’s research. It examines a study of 224 white and Latino young adults who were open about their status as lesbians, gays, or bisexuals to at least one parent or primary caregiver during adolescence. The participants were surveyed regarding the prevalence of 51 rejecting behaviors in their families when they were teenagers. The participants also were asked questions about their mental health status, substance use and abuse history, and sexual risk behavior.

Ryan and her team found that in comparison with peers who reported low or no levels of family rejection, young adults who reported high levels of family rejection were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse. Of the groups studied, Latino men reported the highest number of rejecting behaviors from their families.

The study represents only part of the FAP’s research. To identify rejecting and accepting behaviors, the FAP conducted in-depth interviews with Latino and white LGBT adolescents and their families. Those interviews identified more than 100 behaviors that families used to show acceptance or rejection of their LGBT children. Rejecting behaviors include verbal harassment, physical violence, exclusion from family activities, and prevention of children’s access to the LGBT community. Supporting behaviors included finding children positive LGBT role models and welcoming youths’ LGBT friends and partners.

The FAP is using its research results to develop interventions and educational materials aimed at helping families support their LGBT children and decrease rejecting behaviors. The project has received a nearly $500,000 matching grant from the Robert Wood Johnson Foundation to collaborate with other organizations to develop a family-centered model of care and risk prevention. The interventions are being designed to be culturally appropriate for use with multiethnic families, and the materials are being developed in English, Spanish, and Chinese. There are also plans to disseminate the materials and interventions internationally.

The interventions have the potential for great success with families because they will provide data that show how rejecting behaviors are linked to negative health outcomes, according to Ryan. The FAP’s experience has been that when families are given this information, many of them immediately want to make changes to limit the risk to their children, she says. “We believe that all families love their children and want the best for them and want them to have a good life,” she says. “What they don’t know is that their words, actions, and behaviors have consequences.”

A Shift in Direction
For some organizations that serve the LGBT community, the FAP’s work already has led to changes in how they interact with LGBT youths and their families. For example, Greater Boston Parents, Families & Friends of Lesbians and Gays (PFLAG), a group that supports LGBT people and their parents, families, and friends, has traditionally operated by waiting for people to approach it for assistance and services. But the organization has taken a decidedly more proactive approach recently, a change accelerated by the FAP’s work.

One of the most visible signs of Greater Boston PFLAG’s new approach is its collaboration with the Massachusetts Parent Teacher Association. As part of that collaboration, a booklet by Ryan about parental acceptance has been included in back-to-school packets distributed in Massachusetts schools. The organization also is trying to spread the word of Ryan’s work to other groups, including public health organizations and churches.

“It has changed the way we work and made us rethink the way we do everything we do,” says Stanley Griffith, president of Greater Boston PFLAG. “We are speaking everywhere we can get an invitation to speak. All disciplines need to know about this.”

The San Francisco-based Gay-Straight Alliance Network also is considering how to adopt a new approach in light of Ryan’s research. It is looking at ways in which the organization can incorporate parents more fully into its school-based activities. One gay-straight alliance, for example, has started a parent booster club. It’s a way parents can show support for their children while also providing encouragement to parents who are struggling to accept their child’s LGBT status, says Carolyn Laub, executive director of the Gay-Straight Alliance Network.

“[Ryan’s work] confirms what we knew intuitively—that family members are really key—and it provides clearer guidance about how [a child’s LGBT status] affects families,” Laub says.

Getting a better picture of how to educate families is especially important in situations where parents struggle to reconcile their desire to support their children with their adherence to deeply held religious beliefs, says Valerie Larabee, executive director of the Utah Pride Center. Such struggles are common in Utah, where about 60% of the population is Mormon.

“I think [Ryan’s] work is going to be a real gift for us and our work,” Larabee says. “She’s given us a tool so we can begin to have a conversation where we’re not trying to change parents’ doctrinal beliefs but helping them help their youths feel loved and cared for.”

Getting the Word Out
Although the activities of the FAP have given social workers and other professionals valuable tools to use in engaging LGBT youths and their families, observers say there is more work to be done in creating a more accepting environment for these youths.

A primary challenge is getting information about Ryan’s work to families and the social workers and other professionals who serve them. Many people still do not know about the research, and it will take a concerted effort to spread the word from family to family, Laub says.

And just because families may be more aware of how rejecting behavior negatively impacts LGBT youths, that will not erase the ridicule, scorn, hatred, and even violence that LGBT youths face in American society, Griffith says. Social workers have an important role to play in changing this landscape, he adds.

“The coming-out conversation should be no more difficult than learning that you have a left-handed kid,” Griffith says. “In the meantime, we need to be supportive of the parents.”

— Christina Reardon is a freelance writer based in Harrisburg, PA, and an MSW candidate at Temple University.